HUNTER-BELLEVUE SCHOOL OF NURSING

PHYSICAL ASSESSMENT MIDTERM EVALUATION

NURS 751 HEAD TO TOE PHYSICAL EXAM

Fall 2023 Date: ___________

Student Name: ________________________________

Time Start: _________ Time Finish: ___________

Faculty: Check off Satisfactory (S) or Unsatisfactory (U) following each item. Mark
off Pass or Fail and then sign at end.
All items in brackets {…} are used only if relevant. Not needed for this exam. The
cranial nerves are put in to help you learn them. They are not documented with
CN, etc. next to findings
This is to be used as a guide during class only. When in clinical practice, student
will utilize full PE guidelines (e.g., breast examination).
PATIENT SITTING ON THE EXAM TABLE OR IN A CHAIR
S U
Introduce self & wash hands
SKIN
- Inspects exposed skin: examine face, neck, arms, hands, legs and soles of feet
- Inspect nail beds: nail bed inspection for capillary refill and integrity
HEAD
- Inspect & palpate the skull:
o parts the hair from frontal to occipital region

o pays special attention to area behind ears, hairline, and crown of head

o occipital glands at base of skull

o palpates temporal arteries

o palpates temporomandibular joint with 2 fingertips just anterior to the tragus of ear.

 ask patient to open and close mouth

1
 o palpates facial bones and sinuses: frontal, zygomatic, mandible

o palpates sinuses:

 frontal: thumbs pressed up under body ridge of eyebrow on each side of

nose
 maxillary: thumb or index finger under the zygomatic process

o Clench teeth

o Wrinkle forehead

o Smile

S U
o Stick out tongue and move right to left

o Puff out cheeks

o Squeeze eye tightly shut with eyes closed and test muscular strength by trying to open

EYES
- Inspects eyelids, eyelashes, palpebral folds, sclera, conjunctiva, iris, eyebrow alignment
- Palpate lacrimal glands, ducts
- Evaluate pupil size: direct penlight at nasal bridge from about 30cm and observe for light
symmetrically in both eyes
- Test pupillary response: direct and consensual. Use penlight and have patient look into distance
- Test alignment: patient to look at distant object and then at object 10cm from bridge of nose; watch
for pupillary constriction with near effect
- Test for ocular muscle function:
o Corneal reflex: check with tissue. Etc

o Extraocular muscle movements: hold patient chin and instruct patient to watch finger
movement thru six cardinal fields of gaze. CN III, IV, & VI)
- Performs ophthalmoscopic examination
o Starts with lens on O setting and large aperture

o Holds ophthalmoscope in hand corresponding to the eye examined; maintain finger on lens
selector dial throughout exam

2
 o Stabilizes patient head

o Attempts to visualize: red reflex, lens, disc, cup margins, vessels, retinal surface

EARS

- Inspect ears for size, shape, symmetry, position

- Palpates: auricle, mastoid area, push tragus for tenderness, pull gently on each lobe
- Evaluates auditory acuity for whispered voice test (CN VIII)
o Instructs patient to place finger in ear canal

o Stand behind patient on unobstructed side about 30 – 60 cm (1-2 ft)

o Whisper one or two syllables and ask patient to repeat

o Repeat on opposite side

- Evaluate Weber test (CN VIII)

- Evaluate Rinne test (CN VIII)
- Otoscope Examination:
o Tilts patient’s head toward opposite shoulder

o Pulls patient’s auricle upward and back

o Attempts to visualize canals, tympanic membranes for color, position, landmarks, integrity,
deformities, inflammation
NOSE
- Inspects external position of nose for deviation
- Palpates nasal skeleton from nasal bridge to tip of the nose
- Assess patency of nares: instruct patient to occlude each nares separately and breathe in and out with
mouth closes
- Inspect nasal turbinates: use penlight and inspect nasal mucosa, septum, turbinates
MOUTH
- Inspects lips with mouth closed
- Inspects oral mucosa with penlight and tongue blade with patient’s mouth open

S U
o Buccal mucosa, gingiva, teeth, Stensen’s and Wharton’s ducts, hard and soft palate, tonsils

3
 o Asks patient to touch tip of tongue to palate

o Ask patient to extend tongue and move tongue side to side (CN XII) and observe lateral
borders of tongue for lesions
- Tests glossopharyngeal and vagus nerve function (CN IX, X)
o Inspects posterior pharynx

o Instructs patient to say “ah” and observes uvula movement, palantine arch rise

o Test gag reflex

NECK
- Inspect neck: Instruct patient to slightly hyperextend and swallow; check for jugular vein distention
(JVD)
- Palpate trachea for midline: thumb and forefinger along each side of trachea in lower portion of neck

- Palpates all head and neck lymph nodes

o Preauricular, postauricular, tonsillar, submandibular, submental, superficial cervical, deep
cervical, posterior cervical, supraclavicular
- Palpate thyroid gland using posterior approach:
o Locate landmarks: hyoid bone, thyroid cartilage, cricoid cartilage

o Place two fingers on each hand on sides of trachea just below cricoid

o Ask patient to swallow feeling for movement of isthmus

o Using right hand, displace trachea to left and palpate for main body of left thyroid

o Using left hand, displace trachea to right and palpate for main body of right thyroid

STAND BEHIND PATIENT AND EXPOSE BACK

CHEST AND LUNGS
- Inspect posterior chest wall for symmetry, movement with breathing
- Simultaneously palpates posterior chess wall with ball of hand
- Simultaneously palpates for tactile fremitus using palmar surface of hand and patient saying “99”
repeatedly
- Assess respiratory excursion
o Thumbs at 10th rib on each side spinal column & fingers on lateral thorax

o Patient instructed to take deep breath in and out

4
 o Observe for symmetry of movement

- Symmetrically percuss posterior lungs: superior, inferior, medial and lateral

- Symmetrically auscultate posterior lung fields: superior, inferior, medial and lateral
MOVE IN FRONT OF PATIENT
While patient is sitting
- Inspect anterior chest wall
- Auscultate breath sounds on anterior chest wall: superior, inferior, medial, lateral
CARDIOVASCULAR AND PERIPHERAL VASCULAR
- Auscultate with diaphragm with patient leaning slightly forward: (detects aortic regurgitation
murmurs)
o Left sternal border

o Mitral area

ASSIST PATIENT TO SUPINE POSITION

- Palpate for apical impulse for thrills or heaves using whole hand:
S U

o Apex, left sternal border, base left, base right, right sternal border, epigastrium

- Auscultate with diaphragm following areas:

o Aortic, pulmonic, second pulmonic, tricuspid, mitral

- Auscultate with bell following areas:

o Aortic, pulmonic, second pulmonic, tricuspid, mitral

- Auscultate mitral area with patient in left lateral recumbent position with bell and patient holding
breath (brings out S3, S4 and mitral murmurs)
- Inspect neck for JVD, place patient 30- 45 degree angle
- Palpates and auscultates carotid arteries
o Inspects neck for carotid pulsations

o Palpates carotids one at a time

o Auscultates carotid arteries with bell

- Auscultates vascular sounds with bell of stethoscope:

o Aortic, renal, iliac, femoral

- Palpates peripheral pulses:

5
 o Brachial, radial, femoral, popliteal, dorsalis pedal, posterior tibial

Faculty Comments:

Result: Pass/Fail

Faculty Signature:______________________________

Student Signature:______________________________